Geriatrics
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Practice Guideline Case Reports Guideline
Perioperative risk. Review of two guidelines for assessing older adults. American College of Cardiology and American Heart Association.
Elective in-patient surgery is a common occurrence among older persons and primary care physicians are routinely called on to provide preoperative assessment and perioperative risk management of these patients. Older patients undergoing noncardiac surgery may be at increased risk for cardiac or cardiovascular complications, thus perioperative assessment of risk in this population is prudent. Although the range of possible screens and diagnostic tools can make this task unwieldly, the clinical practice guidelines make it more manageable. Two guidelines in particular--one published jointly by the American College of Cardiology and American Heart Association, the other by the American College of Physicians--are particularly suited to perioperative assessment and risk management.
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The aging kidney is characterized by reduced glomerular filtration rate, loss of tubular volume, and narrowed homeostatic control of water and electrolyte balance. It is unclear whether these physiologic changes represent normal aging or subclinical disease. ⋯ Water metabolism is particularly vulnerable in older patients, resulting in a frequent tendency toward dehydration and hyperosmolality. Understanding these limitations on fluid and electrolyte homeostasis can help the clinician recognize and prevent complications when caring for older patients.